bubble_chart Concept

Retching refers to the symptom of wanting to vomit but only retching, with no substance and only sound, or vomiting a small amount of frothy saliva.

Jingui Yaolue first introduced the term "retching." However, Yixue Rumen considers hiccup as retching, stating, "Hiccup is retching, but the sound is heavier and longer." The "Medical Essentials" states: "Retching has a light, short, and small sound; hiccup has a heavy, loud, and long sound," indicating that the symptoms are similar, differing only in severity. Jingui Yaolue refers to the hiccup condition as what later generations call hiccup.

This condition should be distinguished from hiccup, nausea, and vomiting. Hiccup is characterized by continuous, short sounds; nausea is the feeling of wanting to vomit but not actually vomiting, with no substance or sound; vomiting involves both sound and substance; all of which are different from retching, which involves wanting to vomit and retching, with sound but no substance.

bubble_chart Pattern Analysis

1. Stomach Heat︰Frequent retching with loud sounds, epigastric stuffiness, bitter taste in the mouth, irritability, thirst with desire to drink, or accompanied by abdominal distension and fullness with pain, severe constipation, red tongue texture, yellow and dry or scant tongue coating, and a large and forceful or thin and rapid pulse. Differentiation between deficiency and excess is necessary. When external pathogens invade, progressing from the exterior to the interior and lodging in the Yangming, the pathogens transform into heat and contend with grain qi, rebelling upward and causing the stomach to fail in descending, leading to frequent retching, which belongs to an excess pattern. If residual heat persists after an illness, or if drying medications are mistakenly used, damaging stomach yin, stomach qi also fails to descend and rebels upward, resulting in retching, which belongs to a deficiency pattern. The key points for differentiation between the two: the excess pattern must present with abdominal distension and fullness, constipation, thirst with desire to drink, dry tongue coating, and a large pulse. Treatment should focus on clearing heat and purging the lower, harmonizing the stomach and descending adverse qi, using Stomach-Regulating Purgative Decoction with modifications. The deficiency pattern is characterized by a red tongue with scant coating and a thin, rapid pulse. Treatment should focus on nourishing the stomach to produce fluid and harmonizing and descending rebellious qi, using Bamboo Leaf and Gypsum Decoction with modifications.
2. Stomach Cold︰The retching sound is weak and low, occasionally vomiting a small amount of frothy saliva, with cold pain in the epigastrium and abdomen, or epigastric stuffiness and fullness, aversion to drinking, loose stools, shortness of breath and reluctance to speak, bland taste in the mouth without thirst, pale tongue texture with thin white coating, and deep wiry or thin weak pulse. There is a distinction between deficiency and excess patterns. The excess pattern is caused by external contraction of cold pathogens directly attacking the stomach, or excessive consumption of raw and cold foods, leading to congealing cold and qi stagnation, resulting in stomach disharmony and adverse descent, which causes retching. The deficiency pattern arises from inherent spleen and stomach weakness, or excessive use of cold medications that damage stomach qi, leading to deficiency-cold of the spleen and stomach, abnormal ascent and descent, and stomach qi ascending counterflow, resulting in retching. The key points for differentiation between the two patterns are as follows: - The excess pattern must present with cold pain in the epigastrium and abdomen, white tongue coating, and deep wiry pulse. Treatment should focus on warming the middle and dissipating cold, harmonizing the stomach and descending adverse qi. The formula used is Pinellia and Dried Ginger Powder with modifications. If there is vomiting of a small amount of frothy saliva and slight vertigo, the formula Evodia Decoction with modifications is used. - The deficiency pattern is characterized by epigastric stuffiness and fullness, accompanied by anorexia, loose stools, shortness of breath and reluctance to speak, pale tongue, and thin weak pulse. Treatment should focus on tonifying the spleen and stomach, descending counterflow, and calming the middle. The formula Middle-Regulating Decoction with additions such as Clove, Poria, and Pinellia is used.
3. Liver Qi Depression︰The sound of retching is weak, intermittent, and often triggered by emotional fluctuations, accompanied by restlessness in the chest and hypochondrium, anorexia, a pale red tongue with thin white coating, and a wiry-thin pulse. It is mostly caused by worry, depression, or anger, leading to liver qi stagnation that transversely invades the stomach, resulting in disharmony of stomach qi and retching. The condition originates from liver depression, so it is often induced by emotional fluctuations. The liver fails to act freely, manifesting as restlessness in the chest and hypochondrium. Liver qi invading the stomach leads to anorexia, a thin white tongue coating, and a wiry-thin pulse. Its characteristics include: each episode being related to emotional factors, accompanied by restlessness in the chest and hypochondrium, anorexia, and melancholy. Treatment should focus on soothing the liver and regulating qi, harmonizing the stomach, and descending adverse qi. The recommended formula is Four Seven Decoction with modifications.
4. Food Stagnation︰Retching with foul-smelling belching, the urge to vomit but inability to do so, chest stuffiness, anorexia, epigastric abdominal distension and fullness, foul-smelling stools, thick and greasy tongue coating, and wiry-slippery pulse. Mostly caused by dietary irregularities, excessive consumption of rich and greasy foods or alcohol, leading to food stagnation in the stomach, stomach qi failing to descend normally, and qi counterflow rushing upward, resulting in retching. Key points for pattern identification: clear history of food injury (dyspepsia), symptoms include retching with foul-smelling belching, the urge to vomit but inability to do so, epigastric abdominal distension and fullness, foul-smelling stools, often relieved by vomiting out food. Treatment should focus on harmonizing the stomach and regulating qi, promoting digestion and removing food stagnation. The recommended formula is Harmony-Preserving Pill with modifications.

Retching is primarily caused by the stomach's failure to harmonize and descend, leading to the upward counterflow of qi. Clinically, it is essential to differentiate between cold and heat, deficiency and excess, and to treat based on pattern differentiation. However, the key approach is always to harmonize the stomach and descend adverse qi.

bubble_chart Documentation

1. "On Cold-Damage Disease: Discussion on the Pulse, Symptoms, and Treatment of Jueyin Disease": "For retching, vomiting saliva, and headache, Evodia Decoction is the primary treatment."
2. "The Heart of Medicine": "Vomiting involves both sound and the expulsion of material. Spitting involves material without sound. Hiccups involve sound without material, commonly referred to as retching. Dongyuan attributes these three conditions to spleen-stomach weakness, or the invasion of cold qi, or damage from diet, leading to counterflow of qi and the inability to ingest food. Xiangsha Two Old Ingredients Decoction is the primary treatment."